Bilateral Bispectral Index Monitoring Performance in the Detection of Seizures in Nonanesthetized Epileptic Patients: An Observational Study.

BACKGROUND: The aim of this observational study was to determine whether bilateral bispectral index (BIS) monitoring can detect seizures in epileptic patients. METHODS: Four-channel frontal BIS monitoring and standard 40-channel electroencephalography monitoring were conducted in epileptic patients undergoing evaluation for epilepsy surgery. The BIS numerical value, signal quality index, electromyography, suppression ratio, and color density spectral array were continuously recorded. In patients with electroencephalography-confirmed seizures, the mean value and trend (slope of linear regression) of bilateral BIS monitor parameters were analyzed from 1 minute before to 1 minute after seizure onset. RESULTS: Of 48 patients included in the study, 21 (43.8%) had at least 1 seizure. BIS numerical value was not able to detect focal or focal to bilateral tonic-clonic seizures. Considering all seizures, the only significant differences between recordings 1 minute before and 1 minute after seizure onset were a decrease in the signal quality index slope from 1 hemisphere (0.039±0.297 vs. -0.085±0.321, respectively; P =0.029) and in the mean signal quality index recorded from both hemispheres (left hemisphere: 65.775±30.599 vs. 61.032±26.285; P =0.016 and right hemisphere: 63.244±31.985 vs. 59.837±27.360; 0.029); these differences were not maintained after Hochberg adjustment for multiple comparisons. In seizures occurring during sleep, there was a change in the electromyography slope of 1 hemisphere before and after seizure onset (-0.141±0.176 vs. 0.162±0.140, respectively; P =0.038). There were variable responses in BIS parameters in the 3 patients who developed focal nonconvulsive seizure clusters. CONCLUSION: Bilateral BIS monitoring was not able to detect the occurrence of seizures in epileptic patients.

Conocimientos de diabetes y alimentación y control glucémico en pacientes diabéticos de un hospital de Asunción / Knowledge of Diabetes and Diet and Glycemic Control in Type IIDiabetic Patients froma Hospitalin Asunción

Introducción: Las complicaciones de la Diabetes aparecen como consecuencia de un mal control glucémico lo que podría estar asociado a desconocimiento en el manejo de la enfermedad y la alimentación. Objetivo: Evaluar el conocimiento en diabetes y alimentación y el control glucémico en diabéticos tipo II del Hospital Materno Infantil de Loma Pyta en el periodo agosto-setiembre de 2019. Metodología: Estudio descriptivo transversal, de una muestra no probabilística de pacientes diabéticos tipo II, con aplicación de un cuestionario de características sociodemográficas, clínicas y preguntas sobre características de la diabetes tipo II y alimentación para evaluar el nivel de conocimiento. Se emplearon los test de ANOVA y Test exacto de Fisher para explorar asociaciones, considerando como significancia estadística un valor de p<0,05. Resultados: El buen conocimiento en cuanto a alimentación (31,6%) fue menor frente al de diabetes (58,3%). El valor de hemoglobina glicada promedio fue 9,6%, indicando un mal control metabólico de los pacientes; el nivel de conocimiento se asoció con los valores de glucemia en ayunas (p=0,03); mejor conocimiento se asoció con ser mujer y nivel educativo universitario, no así con ser parte del club de diabéticos. Conclusión: La aplicación de un trabajo educativo sostenido en los pacientes diabéticos podría mejorar el nivel de conocimiento de su enfermedad y alimentación, reflejando las buenas conductas en sus controles metabólicos rutinarios.

Introduction. Diabetes complications appear as a result of poor glycemic control, which could beassociated with ignorance in the management of the disease and food. Objective.To evaluate knowledge in diabetes anddiet and glycemic control in type II diabetics of the Loma PytãMaternal and Child Hospital in the period August-September 2019. Methodology. Cross-sectional descriptive study of a non-probabilistic sample of type diabetic patients II, with the application of a questionnaire of sociodemographic, clinical characteristics and questions about characteristics of type II diabetes and dietto assess the level of knowledge. The ANOVA test andFisher's exact test were used to explore associations, considering a value of p <0.05 as statistical significance. Results.The good knowledge regarding feeding (31.6%) was lower compared todiabetes (58.3%).The average glycated hemoglobin value was 9.6%, indicating a poor metabolic control of the patients; the level of knowledge was associated with fasting blood glucose values (p = 0.03); Better knowledge was associated with being a woman and university education level, but not with being part of the diabetic club. Conclusion. The application of sustained educational work indiabetic patients could improvethe level of knowledge of their disease and diet, reflecting good behaviors in their routine metabolic controls.

Cervical spinal cord injury by a low-impact trauma as an unnoticed cause of cardiorespiratory arrest.

BACKGROUND: Cardiorespiratory arrest (CA) secondary to traumatic cervical spinal cord injury can occur in minor accidents with low-impact trauma and may be overlooked as the cause of CA in patients admitted in the coronary care unit. CASE SUMMARY: We present two patients admitted to the coronary care unit because of suspected CA of cardiac origin. Both patients were found in CA with asystole, one after collapsing in a shopping mall and falling down a few steps and the other in the street next to his bicycle. They underwent early pharmacologically induced coma and hypothermia precluding neurological examination. Both patients remained in coma after rewarming, with preserved brainstem reflexes but absent motor response to pain. One patient had post-anoxic myoclonus in the face without limb involvement. In both patients, median nerve somatosensory evoked potentials demonstrated bilateral absence of thalamocortical N19 responses and abnormal cervicomedullary junction potentials (N13 wave). Extensive diagnostic work-up did not find a cardiac cause of the CA, pulmonary thromboembolism, or intracranial haemorrhage. In both patients, cervical spinal cord injury was diagnosed incidentally 5 and 6 days after CA, when a brain magnetic resonance imaging performed to assess post-anoxic brain injuries detected spinal cord hyperintensities with fracture and luxation of the odontoid. Both patients died 11 and 8 days after CA. DISCUSSION: Low-impact traumatic cervical spinal cord injury should be considered in the diagnostic work-up of patients with CA of unknown cause.

The multiple sclerosis visual pathway cohort: understanding neurodegeneration in MS.

BACKGROUND: Multiple Sclerosis (MS) is an immune-mediated disease of the Central Nervous System with two major underlying etiopathogenic processes: inflammation and neurodegeneration. The latter determines the prognosis of this disease. MS is the main cause of non-traumatic disability in middle-aged populations. FINDINGS: The MS-VisualPath Cohort was set up to study the neurodegenerative component of MS using advanced imaging techniques by focusing on analysis of the visual pathway in a middle-aged MS population in Barcelona, Spain. We started the recruitment of patients in the early phase of MS in 2010 and it remains permanently open. All patients undergo a complete neurological and ophthalmological examination including measurements of physical and disability (Expanded Disability Status Scale; Multiple Sclerosis Functional Composite and neuropsychological tests), disease activity (relapses) and visual function testing (visual acuity, color vision and visual field). The MS-VisualPath protocol also assesses the presence of anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), general quality of life (SF-36) and visual quality of life (25-Item National Eye Institute Visual Function Questionnaire with the 10-Item Neuro-Ophthalmic Supplement). In addition, the imaging protocol includes both retinal (Optical Coherence Tomography and Wide-Field Fundus Imaging) and brain imaging (Magnetic Resonance Imaging). Finally, multifocal Visual Evoked Potentials are used to perform neurophysiological assessment of the visual pathway. DISCUSSION: The analysis of the visual pathway with advance imaging and electrophysilogical tools in parallel with clinical information will provide significant and new knowledge regarding neurodegeneration in MS and provide new clinical and imaging biomarkers to help monitor disease progression in these patients.

Stimulus-induced generalized epileptiform discharges: an unrecognized EEG pattern in refractory nonconvulsive status epilepticus.

PURPOSE: To report an unrecognized EEG pattern occurring in patients with coma with nonconvulsive status epilepticus (NCSE) treated with thiopental and characterized by a high amplitude generalized sharp wave that was induced by isolated or repetitive low frequency photic or tactile stimulation (stimulus-induced generalized epileptiform discharges). METHODS: Review of clinical and EEG records of 4 patients with stimulus-induced generalized epileptiform discharges identified among patients admitted to an intensive care unit (ICU) of our institution who underwent EEG monitoring between July 2011 and January 2013. RESULTS: Four patients had refractory NCSE secondary to hepatic encephalopathy, brain tumor, immunomediated encephalopathy, or anti-NMDA encephalitis. All of them were treated with several antiepileptic drugs and anesthetics, but stimulus-induced generalized epileptiform discharges were only recorded after control of NCSE with thiopental. The discharges occurred without associated clinical manifestations. Two patients died in the ICU, and two had a favorable outcome. Stimulus-induced generalized epileptiform discharges were not recorded in 240 critically ill patients admitted to the ICU who had an EEG recorded during this period. Twenty-two of them were in NCSE, and only one was treated with thiopental. CONCLUSIONS: Stimulus-induced generalized epileptiform discharges is an EEG pattern occurring in patients with NCSE treated with thiopental. The clinical relevance and pathophysiology of stimulus-induced generalized epileptiform discharges remain to be clarified.